In these new times when communication and events are presented in digital format, Research Day, which took place last December, did not fail to reinvent itself in the face of a pandemic that calls for distance. It brought together some of the great drivers of teaching and science and students and gave way to another meeting between two great allies, Medicine and Science. The driving force behind these meetings has been the same for 31 years and is called GAPIC - Office for the Support to Scientific and Technological Research and Innovation. In order to stimulate more scientific thinking among medical students, this Office of the Faculty of Medicine creates scholarships and prizes annually as an incentive so that increasingly translational activity is the path of the future.
This year, Minho and Lisbon got together and under the motto “Research Paths”, Professors Tiago Gil Oliveira, from the University of Minho and Ricardo Fernandes, from the University of Lisbon, were the speakers of excellence. Both with the purpose of presenting the different paths that link Medicine and Science, Tiago Gil Oliveira disclosed the nine-year programme that takes students from Minho to a Ph.D., and Ricardo Fernandes reinforced the importance of Education through Science programmes organised by GAPIC teams and which he also took part as a student and is now involved as an integral element.
A Neuroscience Professor, Tiago Oliveira is a researcher in the field of the hippocampus at the Institute for Research in Life Sciences and Health (ICVS), University of Minho. The doctor is a Neuroradiologist at Braga Hospital and also Vice President of the Portuguese Society of Neurosciences.
“From Guimarães (city where he was born) to New York”, that's how he introduced himself, explaining the clash of worlds of someone who would end up doing his Ph.D. on Alzheimer's Disease at Columbia University.
Defending that students can create good interactions with basic science research, his conviction is that it is necessary to work on strategies to have more medical scientists.
How can the Institutions motivate more medical students to get involved in research, with so many time limitations to study mandatory courses?
Tiago Oliveira: The best way to motivate students to study is to encourage initiatives that demonstrate that medical knowledge based on the best available evidence has a positive impact on the health of populations. Given that this knowledge depends on scientific advances and is in constant re-evaluation, we must work to enable students with skills to manage time to ensure that they stay up to date throughout their professional career.
You said that extracurricular activities should not be seen as such, but as curricular reinforcement. Can you expand on this?
Tiago Oliveira: Medical knowledge alone is not enough to make a doctor complete. It is necessary to acquire other human skills, such as empathy, communication and understanding society as a whole. Extracurricular activities contribute to the training of young doctors, which must be promoted even before students start the medical degree. In addition, these extracurricular activities can have a specific impact on the particular path of each professional, and only later make a difference. Therefore, although time is limited, the acquisition of other skills or involvement in projects must be part of each person's personal planning. In my particular case, I invested early on being fluent in English and have additional training before starting the medical degree. As a student, I always tried to study in the original language of the books, if it was English. Although it was not my initial plan when I entered medicine, I later became interested in research, English being the language used par excellence, and I lived and studied 3 years in the United States, so this time investment in mastering the English language was crucial.
Is the specialty exam what conditions these students the most?
Tiago Oliveira: I am very concerned that many of these students are sacrificing these aspects of training, in addition to the curriculum, and that they fail to gain these skills that make them special, and that they are over-investing in a single exam. I understand the students' concerns about wanting to secure a specialty, but I think it is necessary to reflect on whether we are really training the best doctors this way. What defines a good doctor is much more than a number.
Within Minho's M.D./Ph.D. programme, you have presented the Lab Rotations as a scientific training component for medical students. These programmes last for a month and allow contact with the laboratory reality. Is there any potential for students entering these programmes to continue the proposed research later? Is there capacity to develop the scientific ideas?
Tiago Oliveira: In the particular case of laboratory rotations that students have at the University of Minho, in the context of the M.D./Ph.D. programme, later students have the opportunity to apply for a Ph.D.. In some cases, the work of the rotations acts as a germinative idea for some of the Ph.D. projects. There are also cases of students who, with some additional work, in parallel with the medical degree, manage to publish the results in international journals. These are fantastic examples of the advantages of investing in extracurricular activities.
In your presentation, you used the phrase “A Scientific idea is like a seed”. When you described your journey from being a young man from Guimarães and arriving in NY, I sensed great cultural shock, very natural when comparing the two realities. But you spoke of your research path towards a doctorate and seemed critical in the face of your research choice (brain lipids). You said you had been naive, why? It is not always possible to readjust the question as you go along?
Tiago Oliveira: I said that I made a naive choice for my Ph.D. topic, which focused on the role of signalling lipids in Alzheimer's disease, because I had no idea of the complexity of the research field I was about to enter into. But often this naivety can be positive, because it allows us to take a leap into the unknown and that is how many scientific advances are made. My doctoral supervisor was one of the rising references in the study of lipids in the functioning of the brain and I always had support to guide the planning of experiments. In this context, scientific ideas germinate only when we have a fertile laboratory environment and dedicated guidance. And the research work becomes especially exciting when a discovery leads to new ideas and new experiences, and so we contribute with knowledge that can be a basis for other researchers around the world. I emphasize that the most important thing is that the scientific observations we make are reproducible by other scientists. Some advice I give to young researchers is that they keep some naivety, and pay special attention to the supervisors they choose, because learning solid scientific principles is what will allow them to pass on knowledge as mentors to other subsequent generations. Finally, I advise everyone to leave the comfort zone, as in my case when I went from Guimarães to New York, because they will be exposed to other ways of thinking and other cultures. This is the "doctorate of life" that contributes to personal and scientific growth and also to the training of a more complete doctor.
Ricardo Fernandes, a paediatrician at Santa Maria Hospital, works in the respiratory and allergic areas and carries out research in Clinical Pharmacology. He is also a Professor in this field at the Faculty of Medicine of the University of Lisbon.
It was with his Ph.D. in bronchiolitis, a frequent acute respiratory disease, that he realized the importance and the taste for research, something that allowed him to go on publishing paediatric clinical papers.
Physician - Researcher is “an endangered species”, as he sometimes refers to the group where he fits. When he was a student, he was a GAPIC student and today he is one of the members of the teaching team. He sees GAPIC as the first open door so that the path of medical students can become more scientific, and this will allow them to see their clinical work even more grounded.
Time management and the stimuli that can be given to these new generations are big issues on the table.
In these 31 years of the Research Support Office, the numbers indicate that 14% of medical students have already been involved in GAPIC at least once. Therefore, it is not in vain that the Professor mentions that one wants to “continue to be the origin story of many superheroes who also do research (beyond clinical practice)”. It was based on his ethical mission, to improve the organization between clinical practice and research, that we asked him some questions.
As a Clinician and Researcher, do you feel part of “an endangered species”?
Ricardo Fernandes: The analogy is interesting, because it assumes that there is in fact a well-established "species" of Clinicians-Researchers or Clinical Scientists, which in the past may have been larger in numbers but today is endangered. And it deserves protection by those who preserve it, think and care. In many ways I agree, yes. This topic has been debated and written about for decades, as well as the threats that hover over those who follow this path. Even in countries and models where there is some balance between the assistance and the academic and research aspects. Around here, several academics from our faculty have reflected and contributed deeply to this debate. Looking at the last two decades, which I know a little better, perhaps the biggest challenge is the opposite: the birth of "species", its recognition and integration in a sustained way. It is a heterogeneous community, with different paths, different areas, techniques and rhythms. This was clearly visible in the GAPIC Research Day presentations. And possibly we never had so many opportunities to follow such a path, due to the training offer and the research opportunities. What is more challenging is to face the weaknesses, in particular to balance assistance pressures and competitiveness in research. Extending the analogy, the most protected models of training Clinicians-Researchers "in captivity" need continuity so that, in the wild, they can survive and proliferate...
In a brief assessment of the success of GAPIC in the lives of medical students, one realises that there have been years of much greater adherence and productivity. How do you interpret the evolution of the success of those who organise these Programmes?
Ricardo Fernandes: It depends on what we mean by success. I believe that my colleagues on the current GAPIC team - like those who preceded us and whose steps we followed - will agree that success is not measured exclusively by metrics in number of projects or papers and publications. Of course they count - that's why we have done this monitoring and launched a specific project in this area (PREPIT). It is gratifying to realize that there are outliers of excellence, who start their paths with PEC projects. But for many students, these projects will be a less visible moment, but I hope that equally striking in their contact with science, and above, all their principles.
And what explains years of more successful research and others that are less so?
Ricardo Fernandes: I don't particularly value short-term fluctuations. On the contrary, when looking at the results of these decades of PEC, what I highlight is the continued investment of supervisors and research units, whether basic, translational, clinical or epidemiological, and a reasonably stable flow of participation and interest from students. This is motivating - what GAPIC ensures is a matrix for these encounters to be provided, formalized in support of quality projects, properly framed in the students' academic path.
The 31 years of GAPIC have been encouraging those whom you call “Super Heroes”, because they want to do research, even when the clinical area is their main path. Can you explain this concept?
Ricardo Fernandes: Another interesting analogy! Especially because the recent film culture of the "Super Heroes" has sought to give them a more earthly dimension. That usually makes a difference at decisive moments. It is not a matter of attributing magical attributes to those who follow this path that separate them from their peers. On the contrary, the moment of integrating clinical practice is probably the most challenging and hardest. What we must recognize is the enthusiasm, effort and dedication that these paths imply, with some loneliness and uncertainty at times, particularly when there is a shortage of support structures. But those who know established Clinicians-Researchers are aware of how much they bring to the areas they work in, the units they belong to and the teams they lead, and above all to the patients they care for or, sometimes, even more so, to the patients that others will care for, due to the science they produced about them.
Could the idea of time protected by law to be able to have clinical practice and conduct research be the solution for having more researchers?
Ricardo Fernandes: Protected time consistently appears as one of the highest priorities for Clinicians-Researchers. I believe that this shows what moves us - time to generate and implement ideas and test hypotheses, and to obtain the means that allow it. Time also to formalize dedication to this area of activity, which also has the advantage of requiring feedback and evaluating more rigorously. Implementing this time, considering all legal, labour, and other aspects, is not simple. There are several models and perspectives. Flexibility is important, because the research areas and techniques involved vary. But many solutions have already been used in several countries, many formats tested. It is a pity that at national level some interesting structural proposals have not been continued. At local level, at GAPIC, under the direction of Professor Ana Espada, we have been working on a possible model for CAML - the TIME project.
If the educational institutions worked more in a multidisciplinary way, or if a common teaching programme was created that would necessarily integrate research, would it produce more “Super Heroes”?
Ricardo Fernandes: It seems to me a prerequisite for our times and future times. Because the biomedical sciences have abandoned silos a long time ago. I believe that FMUL in UL's broader network, the IMM and the CHULN, have taken this path. The opportunities are immense. And this ill-fated year has confronted us in a way that is sometimes too cruel, but for other reasons fascinating due to the importance of this integrated perspective. And with the value of all actors and the entire spectrum of biomedical sciences. And how health professionals, particularly doctors, need to be equipped with instruments that allow them to interpret, use and even contribute to the generation, synthesis and implementation of scientific data. Contact with undergraduate research is a fundamental window in this regard; I hope it leaves a seed for the "species" we talked about.